Psychology Research and Behavior Management
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Open Access Full Text Article
Spiritual and religious aspects of skin and skin
disorders
Philip D Shenefelt 1
Debrah A Shenefelt 2
1
Dermatology and Cutaneous Surgery,
University of South Florida, Tampa,
2
Congregation Or Ahavah, Lutz,
FL, USA
Correspondence: Philip D Shenefelt
Dermatology and Cutaneous Surgery
MDC 79, University of South Florida,
12901 Bruce B Downs Blvd, Tampa,
FL 33612, USA
Tel +1 813 974 4270
Fax +1 813 974 4272
Email pshenefe@health.usf.edu
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http://dx.doi.org/10.2147/PRBM.S65578
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Abstract: Skin and skin disorders have had spiritual aspects since ancient times. Skin, hair,
and nails are visible to self and others, and touchable by self and others. The skin is a major
sensory organ. Skin also expresses emotions detectable by others through pallor, coldness,
“goose bumps”, redness, warmth, or sweating. Spiritual and religious significances of skin are
revealed through how much of the skin has been and continues to be covered with what types
of coverings, scalp and beard hair cutting, shaving and styling, skin, nail, and hair coloring and
decorating, tattooing, and intentional scarring of skin. Persons with visible skin disorders have
often been stigmatized or even treated as outcasts. Shamans and other spiritual and religious
healers have brought about healing of skin disorders through spiritual means. Spiritual and
religious interactions with various skin disorders such as psoriasis, leprosy, and vitiligo are
discussed. Religious aspects of skin and skin diseases are evaluated for several major religions,
with a special focus on Judaism, both conventional and kabbalistic.
Keywords: skin, skin disorders, spiritual, religious
Spiritual and religious aspects of skin and skin
disorders
Skin and skin disorders have had spiritual and religious aspects since ancient times.
The shamans who helped our ancestors to survive and who even today in many areas
of the world help to treat skin disorders in part through spiritual means believed that
negative spiritual effects could help produce illness and that positive spiritual effects
could help alleviate illness. The shamans often employed trance-like states known
as altered states of consciousness (ASC) to access the spiritual. There is much still
to be learned from the time-tested shamanic approach to the spiritual through ASC.
Spiritual effects on skin, skin disorders, and healing of skin disorders occur through
mechanisms that medical science is just beginning to understand.
Psychoneuroimmunology of the skin is elucidating how the mind can influence the
skin and skin disorders.1 The modern Western approach to ASC through hypnosis can
be used to produce significant improvement or resolution of many skin disorders.2 As
Dr David Spiegel3 has said, “It is not all mind over matter, but mind matters”. Spirit,
mind, emotions, and body are one holistic unit and each aspect influences skin, skin
disorders, and healing. In this paper the focus will be on how spiritual experiences,
often in ASC, and religious beliefs, rituals, and prayers can affect various aspects of
skin and skin disorders. Several relevant topics will be discussed to help clarify how
such spiritual and religious effects on skin and skin disorders can occur.
Psychology Research and Behavior Management 2014:7 201–212 201
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Shenefelt and Shenefelt
Methods
Online searches were conducted in September and October
2013 in Scopus and in Medline/PubMed extending back as
far as the data base would allow, into the 1960s. Searches
were performed with various combinations of terms, ie,
“spiritual”, “religious”, “skin”, and “skin disease”, as well as
names of common skin diseases including “acne”, “eczema”,
“dermatitis”, “leprosy”, and “psoriasis”. Other references
were obtained from the papers and book chapters as well as
books located through the search process. Bookfinder.com
was also searched for relevant titles. Classical commentary
by Biblical scholars was also included.4–6
Spirituality and spiritual healing
as it relates to skin
Numerous definitions of spirituality exist. According to
Philip Sheldrake, spirituality is centered on the “deepest
values and meanings by which people live”.4 Del Rio and
White define spirituality as “an attitude toward life, making
sense of life, relating to others, and seeking unity with the
transcendent” and distinguish it from religiosity.5 The authors’
definition of spirituality is congruent with this definition and
is conceived of as relating to the essence of being, the core
nature, the energetic gestalt of a person, creature, or thing.
Aldwin et  al also distinguish between religiousness with
its affiliation and service attendance, and spirituality with
its meditative and self-transcendent aspects and note their
effects on health.6 Spirituality can give higher and deeper
meaning to a person’s life and inspires a person to transcend
the ordinary. Spirituality is hidden, not overt, yet can mani-
fest energetically. Spirituality can be experienced from early
childhood onwards, with growth in spiritual maturity often
following life crises.6 High-quality spiritual experiences tend
to promote benefit to many rather than to just one person,
orientation toward service rather than to fame and fortune,
support of love and empowerment rather than fear and nega-
tivity, allowing for choice rather than demanding obedience,
awareness of a higher power rather than claiming ultimate
authority, creativeness rather than rehashing old platitudes,
focus and intelligence rather than being effusive and contra-
dictory, and emphasizing the personal effort and labor needed
for personal growth rather than claiming that enlighten-
ment can occur without work and effort.7 The authors have
observed that the spiritual experience is accompanied by a
shift in consciousness to a more transcendent realm with
broader overall awareness and comprehension of meanings
that expands beyond the immediacy of everyday life toward
higher and deeper experiences. This is a shift to a higher or
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deeper self or higher plane or awareness of a higher being or
greater source of being that is most likely to be experienced
in a spontaneous or an induced trance state, or at least a
transpersonal transcendence to heightened and broadened
awareness. The transcendence beyond ordinary limits may
be accompanied by a sense of nobleness, self-actualization,
altruism, or communication with spirits or deities, or merg-
ing with a supreme being or with nature. The authors have
personally experienced and have had patients and congregants
report that this can result in stress reduction and a feeling of
wellbeing and a personal sense of inner healing and peace-
fulness. It can also increase resiliency. Spirituality can be
expressed through various religious traditions, but is not
confined to religious practice or belief.
On the other hand, spiritual struggle has appeared to
predict poor health outcomes consistently. In the example of
preparing for cardiac surgery, it has been demonstrated that
increased levels of the proinflammatory cytokine interleukin-6
occurred in patients who were struggling spiritually.8 This
elevation in interleukin-6 associated with negative emotions
has been correlated with adverse health outcomes.8
The art of spiritual healing in general and of skin specifi-
cally involves rising beyond the polarities and dualities of con-
scious life toward the wholeness of unity9 found in a heightened
and broadened awareness, often with a shift into an ASC that
becomes dimensionless and timeless. Accompanying that spiri-
tual shift and ASC is usually an emotional shift in polyvagal
autonomic state10 from sympathetic to parasympathetic with
an accompanying shift in body chemistry from sympathetic
fight or flight to dorsal vagal complex rest, digest, repair and
heal, and ventral vagal emotional feeling and expression
with transpersonal engagement. The shifts in emotional and
autonomic states are often required to facilitate and unblock
spiritual and physical healing of the skin.
Brain aspects of spirituality
and spiritual healing mechanisms
Spiritual experiences most frequently occur accompanied
by a shift toward or into an ASC. The brain as an operating
system has several functional modes. The four major func-
tional modes are the ordinary state of consciousness, which
at times includes the hypervigilant state of consciousness, the
ASC, the dreamlike rapid eye movement form of sleep, and
deep sleep. Healing in general and of the skin specifically is
impaired during the hypervigilant state of consciousness and
to a lesser extent during the ordinary state of consciousness,
while healing is usually allowed to proceed during ASC, rapid
eye movement sleep, and deep sleep.10
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The ASC is a daydream-like or trance-like functional
brain mode common in childhood but less so in adulthood,
often with little if any sense of self-awareness. The indi-
vidual may be in one of several possible altered states of
consciousness, which should be kept in mind whenever there
is reference to the ASC. Trance is a deep state of absorption.
There is a shift to parasympathetic autonomic nervous system
dominance associated with vegetative body activities, such as
rest and healing, including healing of the skin.10 This is the
mode in which spiritual experiences are most likely to occur.
The ASC occurs spontaneously and intermittently throughout
the waking time. Individuals vary in how easily they can shift
into ASC. Some individuals have more innate ability to shift
into ASC than others, based on genetic determinants and
brain chemistry. One factor is polymorphism of the catechol-
O-methyltransferase enzyme in the brain that degrades the
neurotransmitter dopamine.11,12 About 15% of individuals
are high-hypnotizable, shifting readily into ASC, and about
15% of individuals are low-hypnotizable, shifting into ASC
with difficulty, if at all. Most individuals (about 70%), are
intermediate in their ability to shift into ASC.13 In deep phases
of ASC, the sense of time disappears as does the sense of a
separate self. In its place, a person may experience merging
into unity (feeling connected with all as one). About 4%
of the population are fantasy-prone, high-hypnotizable,14,15
and those individuals are most likely to have more frequent
spiritual experiences spontaneously or after training in shift-
ing into higher self during ASC. Others who are dissociative
high-hypnotizable or who are medium-hypnotizable may also
have spiritual experiences spontaneously or after training in
shifting into higher self during ASC. There is a precept that
ethical and psychospiritual preparation is important for the
individual to become an appropriate vessel to contain the
spiritual experience. For the spiritual experience, like many
other aspects of life, chance favors the prepared mind.
Spiritual development through
time and its relationship to healing
skin disorders
The earliest spiritual-religious practitioners were shamans.
Among other activities, shamans practiced healing of
spirit, mind, emotions, and body - including skin disorders.
Shamanic techniques still have relevance today to promote
healing of some skin disorders resistant to conventional
approaches. Many shamans in diverse cultures shift into
ASC intentionally, often using auditory driving of drumming
at a range of 180–420 beats per minute, most commonly at
205–220 beats per minute but varying from one culture and
Psychology Research and Behavior Management 2014:7
Spiritual and religious aspects of skin and skin disorders
i­ndividual to another.16 At this beat of about 3.5 cycles per
second with a first overtone of about 7 cycles per second, brain
wave entrainment in the theta range can occur, enhancing shift
into the ASC. Alternatively, shamanic auditory driving may
be done using clicking sticks or rattles.16 ­Repetitive chanting
and singing may also induce ASC in shamans and other par-
ticipants in the ceremony. In some cultures, hallucinogenic
or otherwise mind-altering plant materials may be used to
assist the shaman in attaining ASC. Dancing and fasting
are other methods for attaining ASC. The shaman enters
the ASC with special training and experience for specific
purposes, and in a specific cultural setting with expectations
for specific content. This mode is termed by the authors as
the shamanic state of consciousness and content (SSCC),
and corresponds with what Rock and Krippner call shamanic
patterns of phenomenal properties.17 Again, the individual
may be in one of several possible altered shamanic states
of consciousness, which should be kept in mind whenever
there is reference to the SSCC. The shamanic state of con-
sciousness and the content are two separate aspects that are
combined in the SSCC. Required contents for the SSCC
include a visual mental image or its equivalent in another
sensory system such as auditory or kinesthetic, the outward
appearance of that image must be consistent with a shamanic
cosmology, the image must be consistent with the purpose of
the shamanic journey, and the function of the vision must be
consistent with the vision.17 For the shaman, the nonphysical
world encountered in the SSCC may be considered equally
as real as the physical world.17 Shamans were among the first
psychotherapists, physicians, magicians, performing artists,
storytellers, and weather forecasters.17 Some could also locate
game animals, enemy positions, or lost objects. Typical sha-
manic spiritual treatment elements include suggestion and
imagery, discovery of the cause, removal or release of the
cause, followed by subconscious relearning. These treatments
can be directed when needed toward healing skin conditions,
as discussed further below.
In traditional Eastern culture, the ASC may also be
intentionally entered through concentrative meditation or
mindfulness meditation and in traditional Western culture
more commonly through hypnosis,2 but without the specific
shamanic content. Hassidic Jews commonly use ASC during
mystical chanting, dancing, prayer, and other rituals.18 Their
leader, the Rebbe or a Tzadik, employs shamanistic meth-
ods for soul retrieval, fiery transformations, purification,
telepathic communication, prophesy, and magical healing.18
The Hebrew unpronounced word ‫ יהוה‬consisting only of
vowel sounds and traditionally vocalized as Adonay (Lord)
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Shenefelt and Shenefelt
or HaShem (The Name) according to Jewish Midrash is a
simultaneous combination of the verbs “was, is, will be”
and imparts a sense of energy rather than of a “thing”.19 This
energy could be used for healing. Written language also,
through its abstract symbolic nature, tends to shift toward
male social dominance and linear active left brain processes,
while images in their concrete symbolic nature tend to shift
toward female social dominance and nonlinear healing right
brain processes.20 Intentional shifting from one hemisphere
to the other may be achieved by closing the contralateral
nostril with finger pressure and breathing through only one
nostril.21 This method has been practiced for centuries in
yoga and can help shift the individual toward relaxation and
healing of the skin.10
The ASC usually affords access to the subconscious
and to the superconscious. Quieting the ordinary state of
consciousness and shifting to ASC permits listening to the
subconscious, which is otherwise usually drowned out by the
chatter of the ordinary conscious state. Being in the ASC also
allows intentional changes in autonomic regulation, immune
regulation, and other aspects that are not under the usual
conscious control of the ordinary state of consciousness.
Shifting to ASC also allows listening to or experiencing the
superconscious, the “higher self ”. The right temporal lobe
of the brain has been implicated in spiritual experiences
that may occur in ASC or associated with right temporal
lobe epilepsy.22
Spiritual experiences generally occur in ASC, whether
spontaneous or induced by drumming, chanting, or other
inducers of the ecstatic or trance state, and often involve
the superconscious or “higher self ”. The ASC corresponds
to what we know as nonordinary reality. It is associated in
an indigenous Mesoamerican terminology with the nagual
(pronounced na-wal) totem of the nonmaterial world of
energy and spirit,23 perceived with nonordinary awareness
and in kabbalistic terminology with ‫ עולם הנסתר‬Olam Ha
Nistar or “the concealed or hidden world”. Other terms for
nonordinary reality in other cultures include the unconscious
mind, transpersonal fields, the life force, the collective
unconscious, the chakras, the Tao, and the spirit world.24
The content of the spiritual experience is influenced by
culture, training, beliefs, expectations, and motivations and
yearnings. Because spiritual experiences are in ASC and
nonordinary reality, the spiritual experiences often become
difficult to express or to remember accurately in the ordinary
state of consciousness and ordinary reality. Some shamans
and mystics develop the ability to transition rapidly back
and forth between nonordinary reality and ordinary ­reality
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by shifting between trance and ordinary alert states. Other
shamans and mystics develop the ability to remain in a
very light trance or SSCC for prolonged periods where
they can perceive nonordinary reality and ordinary reality
simultaneously. Trance induction was indicated on a 3,000-
year-old stele in Egypt, in sleep temples in ancient Greece,
and in the Bible at Genesis 2:21, 1 Samuel 26:12, Job 4:13
and 33:15, and Acts 10:10.25 Healing insights or instructions
may occur during ASC in nonordinary reality that assist in
helping to improve skin problems.
Spiritual experiences may also occur during dreaming
in rapid eye movement sleep. Again there may be difficulty
remembering the spiritual experiences accurately upon
awakening, so some use journaling at intervals during the
night or immediately upon awakening to preserve the dream
contents. Some shamans, such as those in Australia, use the
dream time more than ASC as their preferred mode of spiri-
tual connection. Spiritual dream experiences are recorded
repeatedly in the Bible26 in Genesis 20:3, 20:6, 31:10, 31:11,
31:24, 37:5, 37:6, 37:9, 37:10, 40:5, 40:8, 40:9, 40:16, 41:7,
41:8, 41:11, 41:12, 41:15, 41:17, 41:22, 41:25, 41:26, and
41:32, Numbers 12:6, Judges 7:13 and 7:15, 1 Kings 3:5, Job
20:8 and 33:15, Psalms 73:20 and 126:1, Ecclesiastes 5:3,
Isaiah 29:7, Jeremiah 23:28, Daniel 2:1, 2:3, 2:4, 2:5, 2:6,
2:7, 2;9, 2:26, 2:28, 2:36, 2:45, 4:5, 4:6, 4:7, 4:8, 4:9, 4:18,
4:19, and 7:1, Joel 2:28, Matthew 1:20, 2:12, 2:19,2:22, and
27:19, and Acts 2:17. Dream interpretation is complex and
can become quite esoteric, such as the Zoharic kabbalistic
explication of Joseph’s interpretation of Pharaoh’s dream
described in Wolfson’s book on dream interpretation.27
Dreams may also provide insights or instructions in how to
help heal skin disorders.
Religion and religious healing
as it relates to skin
Religion also has many definitions. The anthropologist
Clifford Geertz defined religion as a “system of symbols
which acts to establish powerful, pervasive, and long-lasting
moods and motivations in men by formulating conceptions
of a general order of existence and clothing these conceptions
with such an aura of factuality that the moods and motiva-
tions seem uniquely realistic”.28 Religion, as described by the
authors for the purposes of this paper, is congruent with this
broad definition and is a personal or group attempt to make
sense of the world and to learn how to behave based on beliefs,
practices, and cultural, linguistic, and many other factors.
Organized religion is a group of believers who accept a
common set of beliefs, practices, and rituals derived from
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sacred stories and myths. There is broad acceptance based
on moments of heightened consciousness or ASC of his-
torical and mythological figures regarding spiritual issues
that concern existence and meaning. Religion has also
been facetiously defined as being the politics of spirituality
(attributed to Bill Olson). Often a religion is based on the
spiritual experiences of the mythical or real leader or leaders
who formed the religion. A person can have spiritual experi-
ences and not be religious, or a person can be religious but
unaware of or uninterested in spiritual experiences. In kab-
balistic terms, spirituality can be associated with the loving
kindness of the sephira of Chesed, being open and spontane-
ous, freeing, warm, fruitful, and full of light, while religion
can be associated with the strength, discipline, boundaries,
and restrictiveness of the sephira of Gevurah, being ritu-
alistic, legalistic, limiting, and sometimes concerned with
domination.29 Religion without the spirit is often lifeless, but
spirituality without religion may be too lacking in discipline.
Kabbalistic healing rituals have been developed, including
rituals for healing skin disorders, such as visualizing the
sefirotic flow of energy for healing skin disorders.
With respect to religious historical development and religious
healing, shamans preceded other forms of religious practitio-
ners. Considerable insight into religious development can be
obtained through familiarity with shamanism. Garb presents
the Hassidic Tzadik as a shamanistic practitioner.18 An analysis
of magicoreligious practitioners by ­Winkelman30 showed
that there are four main groups of practitioners worldwide,
ie, shaman, priest, diviner, and sorcerer/witch. The shaman
is generally found in hunter-gatherer societies without agri-
culture and uses SSCC for healing and divination. The word
“shaman” derives from the Russian adaptation of the Tungus
“saman”, meaning “one who sees”. Each shaman usually has
several helping spirits the shaman encounters and with whom
the shaman develops relationships with when in SSCC. Tales
of shamans journeying or witches flying reflect their use of
ASC.31 With adoption of agriculture and a semisedentary life-
style, the role of the shaman is adapted to that of a shamanic
healer with continued use of SSCC to a lesser extent, to a
shamanistic healer with less use of SSCC, to a medium with
continued use of ASC, or to a healer without much if any use
of ASC. The priest employs sociopolitical and religious power
over believers and engages in magicoreligious agricultural rites
and propitiation of gods for socioeconomic protection, largely
through sacrifices of one type or another. Priests generally do
not use ASC and may not have had direct experiences with
spirits. Krippner and Welch used Winkelman’s categories in
describing a number of contemporary shamans, shamanic
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Spiritual and religious aspects of skin and skin disorders
healers, shamanistic healers, priests and religious healers,
mediums and spiritists, and sorcerers and witches, many of
whom they interviewed.7 Each of these can be involved in
religious healing, some more than others. The placebo effect is
one factor in achieving a healing. The typical healing sequence
within the specific framework of the particular cultural and
religious beliefs is first disruption of habitual frames of refer-
ence, then reframing the situation as a transformative process
in pursuit of revitalization and healing.18 This applies to healing
of skin disorders as well.
Spiritual aspects of skin
Physical attributes of one’s own skin contribute to the spiri-
tual core concept of self and others. The skin is the largest
organ of the body and provides separation and protection,
touch and contact, expression and representation, maternal-
infant bonding with breast feeding stimulating release of
oxytocin in the brain, intimate sexual contact and frictional
stimulation with release of oxytocin in the brain at climax,
excretion through sweat, and temperature regulation through
dilation or constriction of surface blood vessels and through
evaporation from sweating. Emotional sweating changes are
easily detected by electrodes through galvanic skin resis-
tance measurements, and measurement of the galvanic skin
response is an important part of “lie detector” tests.32 The
skin is both the separator and the connector between self
and others, and can affect spiritual intimacy with another,
a spiritual leader, or a higher power. The skin projects to self
and others both physical health or illness and emotional reac-
tions and responses. Skin, hair, and nails at times may reflect
inner issues of the body, emotions, psychological states, and
spiritual being and meaning.9
The nervous system and the skin remain intimately con-
nected throughout life. The more spiritually developed the
person becomes, the more aware he or she is of what drives
his or her life choices, and whether the ego or the soul is
directing. On the physical sensation level, this occurs as
molecular, biochemical, and electrical interactions between
skin cells and nerve cells. On the emotional feeling level,
skin blushing or pallor and warmth or coldness reflect some
emotional states. On the cognitive thought level, the appear-
ance of our skin, hair, and nails influences our thoughts and
vice versa. Anzieu33 speaks of the skin ego, a psychological
semipermeable membrane that separates self from other but
permits interchange. On the social level, the appearance of
our skin, hair, and nails influences social interactions as well
as internal psychical self interactions.34–36 On the spiritual
level, the perception of the skin can influence the core self,
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Shenefelt and Shenefelt
relationships between people, and a person’s relationship with
the Great Unknowable (also known spiritually and religiously
as God, ‫[ יהוה‬YHVH, voiced as Adonay], Allah, Manitou,
Wakan Tanka, and a multitude of other names).
There are numerous metaphors relating to skin. ­Sensitive
people may be referred to as “thin-skinned”, while insen-
sitive people are called “thick-skinned”. Irritation may
be expressed as “he got under my skin”. These boundary
metaphors sometimes include spiritual overtones.37 For
example, the metaphor of shedding one’s skin like a snake
can invoke an image of inner growth and transformation.
All of these aspects and thoughts related to skin add to the
spiritual core concept of self and others.
The skin is also associated with subtle energies, electrical
charges, auras, energy meridians and points, and other fea-
tures often less detected and described in Western culture.38
These can variously be seen, palpated (felt), or detected by
effects produced. Acupuncture meridians have been most
elaborately described in traditional Chinese medicine, but
have been noted in other cultures also.
The type and extent of clothing can have spiritual as well
as social and religious aspects. Clothing covers the skin and
can vary from none such as in certain tribal cultures or ­nudist
camps to complete coverage of all skin, such as a burqa.
Varying degrees of individual expression are acceptable
amongst different cultures. Clothing represents nonverbal
communication and social identity.39 While tightly woven
cloth or animal skin clothing protects the skin from ultraviolet
damage and can protect the skin from heat, cold, and some
forms of physical trauma, it can also have designs on it based
on spiritual visions.
Skin coloring with makeup, paint, or tattooing has
reflected spiritual aspects and dimensions. Examples of the
spiritual and social value of applying red paint on the skin
have been present in many cultures from ancient times to the
present day. Red ochre coloring, a natural earth pigment with
iron in hematite or dehydrated iron oxide form, for painting
skin has been identified from 100,000 years ago at Blombos
Cave, South Africa.40 Pict warriors in Scotland painted them-
selves with red ochre as did Chumash Indians in California
and the Moche in Peru. Ancient Egyptian women used it as
lipstick and rouge. Bones painted with red ochre were found
in Australia dating back 62,000 years. Australian aborigines
have used red, yellow, and brown ochre for painting their
bodies, boomerangs, and rock art based on spiritual visions
during dreamtime. Currently, the Maasai paint their bodies
with red ochre. This red paint on the skin has been associ-
ated with blood, power, fertility, life, and death, all of which
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have been further associated with spiritual and existential
quests.40
Makeup can in some instances reflect spiritual self-
­expression based on visions. It includes various shades of paint,
base, powder, blusher, eye liner, eye shadow, and lipstick. Hair
coloring with various dyes and bleaches is also widespread, as
is the use of curling and straightening processes. These can also
help depict spiritual experiences or visions. Facial masks based
on visions have been worn for spiritual as well as religious
purposes.41 Wigs and hair weaves also change the appearance.
Some orthodox Jewish women wear a sheitel as a form of
modesty as a spiritual or religious practice. While in Western
culture skin coloring with makeup, hair dying, and nail polish
are often used primarily to enhance attractiveness and to mask
flaws in the skin, hair, or nails; in some cultures they can also
indicate social status and individualistic expression, including
spiritual aspects. In India, the bindi dot on the forehead is an
indication of high caste. Women in India traditionally color
their hair part with henna, and for their wedding often have
elaborate patterns of henna staining on their hands. Subcultures
and religions have their own norms and taboos with respect to
skin, hair, and nail coloring. This can have both religious and
personal spiritual symbolism.41
Skin tattooing can be performed by piercing the skin with
a needle covered with pigment. Charcoal has served as a black
tattoo pigment for centuries. Perhaps the first tattoos were
accidental, with the skin being pierced by a sharp burned stick
coated with charcoal soot.42 Ötzi, a 5,300-year-old mummy
found frozen in the Ötztal Alps, had 39 tattoos, many located
at acupuncture sites, and correlated with evidence of disease,
such as arthritis, for which use of those acupuncture sites
could have been beneficial. Other prehistoric frozen mum-
mies from Siberia, Peru, and Chile have been discovered
with decorative tattoos.42 The word tattoo comes from the
Tahitian word “tatu” that means to mark something. In Tahi-
tian mythology, one of the sons of the creator taught humans
the art of tattooing. This was considered a sacred art form or
“tapu” and was performed by shamans “tahua” who knew
the religious ritual associated with tattooing, the meaning of
the designs, and the methodology.43
Skin piercing allows attachment of ornaments to the
skin. While the most common is pierced earlobes, pierced
umbilicus, eyebrow, nostril, lip, tongue, nipple, or genitals
are also found. They can be a form of spiritual expression
through the symbolism of the ornament as well as having
other individual, social, and cultural dimensions.
Intentional scarring of the skin can be an expression of
spirituality or culture. Some individuals form hypertrophic
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scars, and in groups where this trait is common, patterns of
scarring can help to identify individuals as well as permit
individual spiritual expression based on visions.
Scalp hair can be grown long, cut short, shaved, dyed,
bleached, made wavy or straight, and worn in many styles.
Within a given range of cultural acceptance, there is often
a fairly wide range of opportunity for individual expression
with scalp hair, and in men with beard hair. This permits
individual spiritual expression based on visions or others’
spiritual experiences. Body hair can also permit spiritual
expression within a culturally acceptable range.
Religious aspects of skin
Skin and skin disorders have also had religious aspects since
ancient times. How much skin is covered with what kind of
clothing, how the scalp and beard hair are cut and styled,
skin, hair and nail coloring and decorating, skin tattooing,
skin piercing with wearing of ornaments, and intentional
scarring of skin all have had and continue to have spiritual
and religious significance. Skin, hair, and nails are visible to
self and others, and are touchable by self and others. At the
outer layer of the body that presents itself to self and others,
skin has major psychological and social effects on how we
view self and others. Persons with visible skin disorders have
often been stigmatized or even treated as outcasts. Various
skin disorders, such as psoriasis, leprosy, and vitiligo, have
spiritual and religious aspects. Religious aspects of skin
and skin diseases are evaluated for several major religions,
with a special focus on Judaism, both conventional and
kabbalistic.
Religious beliefs and customs often determine the cultural
norms of believers with respect to how much skin is exposed,
types of clothing worn, type if any of skin painting or cos-
metics, use of facial masks and costumes in ceremonies, hair
styles and coloring, nail styles and coloring, tattooing with
religious themes, scarification, piercings, and types of jewelry
worn that have religious significance. The anthropological
literature43 has extensively described these factors for many
cultures and the religious meanings attached to them in each
culture and religion.
The skin is mentioned in the Hebrew Bible a number of
times, and reflects specific religious values and goals. For
example, when Moses descended from Mount Sinai, the skin
ohr ‫ עור‬of his face shone karan ‫ קרן‬like rays of light26 (Exodus
34:29, 34:30, 34:35). The Hebrew word ‫ עור‬for skin is pro-
nounced the same as the Hebrew word ‫ אור‬for light, further
suggesting some connectedness between skin and light. Light
is a prominent metaphor for spiritual flow of beneficent energy.
Psychology Research and Behavior Management 2014:7
Spiritual and religious aspects of skin and skin disorders
Returning a borrowed cloak by sunset to permit the owner
to cover the skin with it for night-time sleep is mentioned in
Exodus 22:27. In Judaism, as in other religions, moral behav-
ior is foundational for personal development. Ezekiel’s vision
of redemption consisted of reconstituting the body from dried
bones including the covering of the body with skin (with these
resurrected people symbolizing the hope for a return of the
people from exile to the land of Israel) (Ezekiel 37:6, 37:8,
37:12). Micah described the skin being flayed off (“skinned”)
in Micah 3:3. If a slave agreed to be a permanent slave, the
antithesis of the laws governing slavery, his ear was pierced
with an awl as described in Exodus 21:6 and Deuteronomy
15:17. Otherwise, piercing and tattooing is proscribed in
orthodox Jewish practice.44
Male circumcision involves cutting off the penile foreskin,
as was done starting with Abraham in Genesis 17:10, 17:12,
17:13, 17:14, 17:23, 17:24, 17:25, 17:26, and 17:27, and
continues to be practiced by Jewish families to this day. This
removal of a portion of the male genital skin empowers a male
child to be entered into a sacred covenant within Jewish tradi-
tion. This has both religious significance and health effects.
Skin infections that tend to occur under the foreskin are usu-
ally avoided in the circumcised. Abraham circumcised Isaac
at 8 days of age in Genesis 21:4. Circumcision of the penile
foreskin is prescribed in Genesis 34:1, 34:22 and in Exodus
12:44, 12:48, Leviticus 12:3, and Joshua 5:3, 5:5, 5:7. Jewish
males continue to be ritually circumcised when 8 days of age
and are thereby entered into the covenant of Abraham. By
analogy, circumcising the foreskin of your heart is spoken of
in Deuteronomy 10:16, Deuteronomy 30:6, and Jeremiah 4:4
as ways of spiritually and religiously overcoming the hardened
heart. Skin color is mentioned in Jeremiah 13:23: “Can the
Ethiopian change his skin, or the leopard his spots?” Boils
were mentioned as one of the ten plagues in Exodus 9:11 and
as afflicting Job from head to toe in Job 2:7. Lice were also
mentioned as one of the ten plagues in Exodus 8:16–18 that
preceded the liberation by ‫( יהוה‬this holy name is not translated
in Jewish tradition, it is too holy to be spoken) of the Israelites
from Egypt. Ritual cleansing of a priest or other person was
performed by placing blood from a ritually sacrificed animal
onto the skin of the right ear, right thumb, and right great toe in
Leviticus 14:14, 14:17, 14:25, or oil could be used in place of
blood as in Leviticus 14:28. Blood was considered to contain
the spiritual life force of the animal. Anointing the skin on a
person’s head with oil was also considered a sanctifying act
when performed in the appropriate ritual, as in Exodus 28:41,
29:7, 30:30, 40:15, and Leviticus 16:32. Anointing the skin of
a king sanctified him, as in Judges 9:8, 1 Samuel 9:16, 15:1,
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207
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Shenefelt and Shenefelt
16:22, 1 Kings 1:34, 19:15, 19:16. Anointing the skin with
oil continues to be a way of consecrating (making  sacred)
Christian priests, ministers, and lay people. Washing the skin
with water in a ritual bath was also a common form of spiritual
cleansing, as in Leviticus 15:5, 15:6, 15:7, 15:8, 15:10, 15:11,
15:13.15:18, 15:21, 15:22, 15:27, Leviticus 16:26, 16:28,
Leviticus 17:15, 17:16, Numbers 19:7, 19:8, 19:19.26,45–47
Immersing three times in a ritual bath called a “mikvah” has
continued to be a Jewish spiritual practice, performed after
menses, before marriage, after childbirth, at conversion,
before Shabbat and other holidays, and at other appropriate
times or times of need of spiritual cleansing or transformation.
­Similarly, baptism was used by John the Baptist, as in Matthew
3:11, Mark 1:4, 1:8, Luke 3:16, John 1:26, 1:33, to cleanse
his followers and to cleanse Jesus. Cleansing the skin with
water by immersion or sprinkling has continued as baptism
in Christianity and in the Mandaean faith. Symbolically, it
is not just the skin but the whole person that is cleansed and
sanctified in most of these religious traditions.
Religious clothing can be considered a second skin. It
varies from none for certain Hindu holy men48 to mostly
covered, as with traditional Roman Catholic nuns, other
Christian monks, nuns, and priests,39 Muslim women wearing
the hijab with or without veil, Buddhist monks and nuns in
flowing robes with shaven scalps, shamans in costumes with
or without masks, Jewish men with kippot head coverings,
prayer shawls, and tefillin, and a wide variety of other types
of clothing with religious significance. Amulets may be worn
as necklaces for protection.
Tattoos were banned in Judaism based on the injunction
in Leviticus 19:28 not to tattoo, perhaps in part because
surrounding peoples that the Jews separated from did tattoo.
Tattoos and piercings are prohibited in traditional Judaism
because the dead are expected to rise from their graves with
the arrival of the Messiah. The bodies are expected to look
the same as before death and be in their original created
states. Tattoos were also discouraged in Christianity based
on considering the body a temple of the Holy Spirit in
1 Corinthians 6:19–20.43 In Hinduism, tattoos were wide-
spread and represented devotional themes. A number of
cultures, including the Maori in New Zealand and the Lakota
in North America, believed that after death a spirit would
recognize the tattoo patterns specific to the tribes and allow
them passage into the afterlife.43 Many cultures also used
tattoos for protection to ward off misfortune or evil. Ainu
women in Japan tattooed their body with an image of their
goddess for protection.43 Islamic Iraqis may tattoo a dot on the
tip of a child’s nose for protection against illness. In Southeast
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Asia, Buddhists in Myanmar, Cambodia, and Thailand often
believe in the protective power of a tattoo. Sacred texts and
images may cover large portions of the body.49 In Thailand,
an initiation rite called the “Krob Kru” involves a religious
ritual with tattooing sacred text followed by testing of the
protection with sword swipes performed by a shaman.50
Spiritual aspects of skin disorders
The skin is a great projection screen onto which physical,
emotional, mental, and spiritual aspects of the person are
constantly made visible.9 As with other challenging physical
conditions, visible skin disorders can have significant psycho-
logical and social effects. The afflicted person may seek to
understand if there are spiritual implications buried beneath
the skin disorder, either as a matter of being deserved or of
reflecting their psychic shadow. According to Dethlefsen and
Dahlke,9 the polarity resulting from the person not unifying
with their shadow aspects can result in psychological distur-
bances, functional psychosomatic disturbances, acute physi-
cal disturbances such as acute skin inflammation, chronic
conditions such as acne or psoriasis, incurable processes
such as metastatic melanoma, or karmic conditions such as
congenital defects or genetic abnormalities.
Inflammatory skin disorders such as acne and skin erup-
tions may point to a variety of spiritual concerns. Childhood
atopic dermatitis or eczema can impair child-maternal rela-
tionships, and early childhood relationships are often key
factors in a person’s capacity to experience spiritual and psy-
chological intimacy. Itching can sometimes mean that some-
thing is biting or “bugging” a person on a psychospiritual
level. Psoriasis can symbolically provide an armored shell
for protection, but it can also impair emotional and spiritual
intimacy. Congenital skin defects such as hemangiomas or
large nevocellular nevi can impair the appearance, as can
genetic skin disorders such as ichthyosis (“fish-skin disease”).
Visible benign tumors such as syringomas or seborrheic kera-
toses can impair appearance. Malignant tumors such as basal
cell or squamous cell carcinoma can lead to treatments that
result in disfigurement from scarring. Malignant melanoma,
if invasive, can become metastatic and life-threatening. All
of these physically deforming conditions can raise existential
issues and provoke searches for meaning in the afflicted.
Flaherty51 sought relief from his severe eczema through
shamanic rituals in Peru that involved shamanic counseling
and chemically ASC through ayahuasca. His eczema had
failed conventional medical treatments and acupuncture
in England, and he had been incapacitated for a year. After
a number of shamanic rituals involving ayahuasca in the
Psychology Research and Behavior Management 2014:7
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Peruvian Amazon, he felt a dramatic spiritual shift and his
eczema cleared rapidly; he has remained almost clear for over
7 years following the spiritual experience. Sandra Ingerman,
a well known shamanic practitioner, has stated to one of the
authors (PDS) that she has seen some good results with rashes
and eczema being healed from shamanic work, but she has
not written down or published these experiences.
Carson52 reported that a primary care physician colleague
of hers had a female patient with a cutaneous ulcer from a
non-healing spider bite reaction and also had depression. The
ulcer had failed to heal despite 17 previous surgeries. While
the patient was hospitalized, the physician with the patient’s
permission did a shamanic journey for her, employing the
physician’s helping spirits. When the physician later dis-
cussed the shamanic journey with the patient, her depression
lifted and she was able to have two successful skin grafts for
the first time over the ulcer at the bite area.
LeShan53 described a case of distance healing of pso-
riasis through prayer. A man with intractable psoriasis for
18 months noted a change when a healer 50 miles away prayed
to God to do whatever was best for the healee. The psoriasis
improved and disappeared within a few days, staying clear
on follow-up 2 years later.
Psychosomatic hypnoanalysis can also be used to explore
the psychological and spiritual aspects of skin disorders. Using
the mnemonic “COMPASS” for the seven key issues described
by LeCron and Cheek, ie, conflict, organ language, motivation,
past traumatic experiences, active identification, self punish-
ment, and suggestion, it is possible in hypnotic ASC to explore
these areas for psychological and spiritual issues that relate to
the skin disorder.54 Conflict is usually between “I want” to do
one thing and “I ought” to do another, and can result in itching,
hives, rashes, or other skin issues. The organ language involves
the skin, for example, “he got under my skin”, “she made my
skin crawl”, and “I have been itching to”. Motivation or second-
ary gain often involves being excused from having to do certain
duties or obligations because of the skin disorder.
Past traumatic experiences involve a memory that links
to the skin. For example, Ewin and Eimer55 relate use of
psychosomatic hypnoanalysis with a medical student who
got hives every time that he ate chocolate. When the medi-
cal student was age-regressed in trance to about 4 years of
age, he recalled visiting a zoo with his parents on a Saturday
afternoon. It happened to be feeding time for the snakes, and
he witnessed with great horror as a large snake ingested a
rabbit. The next morning happened to be Easter Sunday, and
of course he found in his Easter basket a chocolate bunny.
Upon eating the chocolate bunny, he broke out in hives, and
Psychology Research and Behavior Management 2014:7
Spiritual and religious aspects of skin and skin disorders
continued to get hives every time he ate chocolate thereafter.
Ewin provided suggestions that he would no longer need to
develop hives when eating chocolate. The medical student was
able to process this recovered memory as an adult and tested
himself by eating chocolate and no longer developed hives.
Active identification occurs when a powerful other, such as
a parent, had a similar skin problem. Self punishment occurs
when the skin disorder is related to something that the person
feels guilt about. Suggestion occurs when a powerful other,
such as a parent, suggests something related to the skin that
the person internalizes subconsciously. Sometimes these items
may have spiritual aspects of existential concerns or meanings
that require some exploration or reframing. Another example
related by Ewin and Eimer was of a Roman Catholic priest
who developed intense skin itching shortly after a married
woman parishioner made a pass at him. Ewin told the priest
that it was obvious what the priest was itching for, and then
quoted biblical passages and reframed the incident, after
which the priest’s itching promptly went away.55
Religious aspects of skin disorders
Skin diseases rather vaguely specified, and often translated as
a rising, a scab, a bright spot, a white spot like the plague of
leprosy tsara’at ‫צרעת‬, are mentioned in the Hebrew Bible in a
number of locations. The word “tsara’at” means to be thrown
down or humiliated. The King James version of the Bible trans-
lates tsara’at as leprosy, but this is not how the word is translated
by Hebrew biblical scholars, such as Milgrom.56 In biblical
times, this condition was more likely akin to psoriasis or vitiligo
than to our modern understanding of the mycobacterial disease
leprosy.56 Scaling disease that penetrates into the skin, often
translated as leprosy, was seen as a physical punishment for
religious or moral transgressions. In Exodus 4:6–4:8, Adonay
instructed Moses to put his hand inside his cloak and when
Moses took it out, it was leprous like snow. Moses was told to
put his hand back in his cloak and it came out normal. Moses
was to use this as a sign of God’s power to punish. Leprosy was
discussed extensively in Parsha Metzorah (meaning “leprous”),
Leviticus 13:2, 13:3, 13:4, 13:5, 13:6, 13:7, 13:8 (shiny marks
deeper than superficial); 13:9, 13:10, 13:11, 13:12, 13:13,
13:15 (discolorations); 13:18, 13:20, 13:21, 13:22 (boils);
13:24, 13:25, 13:26, 13:27, 13:28 (burns); 13:29, 13:30, 13:31,
13:32, 13:34, 13:35, 13:36 (sores); 13:38, 13:39 (white spots);
13:42, 13:43, 13:44 (discolored baldness); 13:45 (requirement
to cry “unclean” and live apart); 13:47, 13:48, 13:49, 13:51,
13:52, 13:53, 13:56, 13:57, 13:58, 13:59 (spots on fabrics), and
Leviticus 14:2, 14:3, 14:7, 14:32 (cleansing of cured leper);
14:34, 14:44, 14:54, 14:55, 14:57 (spotted mildew on houses
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Shenefelt and Shenefelt
also considered to be leprosy); also Deuteronomy 24:8, 2
Kings 5:1, 5:3, 5:6, 5:7, 5:27, and 2 Chronicles 26:19. Persons
with these conditions were considered ritually impure, with
the presumption that their skin disorder was associated with
transgression or immorality. The person was to be separated
from the community for 7 days and then re-examined by a
priest. They were to cry out “unclean” when others approached
so that the others could avoid spiritual, but interestingly not
physical, contamination. The ancient Jews believed that certain
transgressions were airborne, and it was exposure to the spirit
of the transgressor, above its manifestation through the skin
that needed to be avoided though quarantine of the individual
affected. However, once the penitent’s skin had cleared, he
or she was cleansed through a priestly ritual and welcomed
back into the community. Levites who had skin blemishes or
skin disorders were not permitted to function as priests. When
Miriam slandered Moses in Numbers 12:1–15, Adonay sum-
moned Moses, Aaron, and Miriam to the Tent of Meeting and
afflicted Miriam with leprosy like snow in Numbers 12:10.
Nachman57 attributed leprosy to slander based on the story of
Miriam. Moses prayed for Adonay to heal her. Miriam was
quarantined for a week and was healed, and rejoined the com-
munity. Midrash Tanchuma Metzora 7, 24a, and 22b extends the
notion that leprosy is a punishment for slander.58 The biblical
concept of leprosy and being ritually unclean was extended to
spotted clothing and spotted houses.
In the New Testament, leprosy (lepra λέπρα) is mentioned
in Matthew 8:3, Mark 1:42, Luke 5:12, 5:13. ­Christians asso-
ciated leprosy with sin. Leprosy (‫ )الأبرص‬is also one of the
diseases mentioned in the Quran in the context of the miracles
of the prophet Jesus, in verse 5:110 of chapter 5 sūrat l-māidah
(The Table Spread with Food). The Greek “lepra” means scaly
or defilement. Many scaly skin disorders occur that in ancient
times were not differentiated from leprosy, including psoriasis,
dermatitis, xerosis, ichthyosis, and the mycobacterial disease
currently known as leprosy. Similarly in Hinduism in ancient
India, the Atharava Veda (about 2000 BC) and the Laws of
Manu (1500 BC) mention various skin diseases translated as
leprosy. The Laws prohibited contact with those affected by
leprosy and punished those who married into their families,
ostracizing those with the disease for their past sins. The
Sushruta Samhita (600 BC) recommended treating leprosy
(or kushtha, meaning “eating away” in Sanskrit) with oil
derived from the chaulmoogra tree. While Hinduism usually
considered suicide a sin, for leprosy it was not.59 In Buddhism,
leprosy was considered karma and the person was an outcast,
but considered compassionately with assistance in local lep-
rosaria. Mycobacterium leprae as the causative organism was
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not identified until 1873. Other skin diseases such as psoriasis
and vitiligo may be mistaken by lay persons for leprosy. Social
aversion to skin disorders has promoted ostracism of individu-
als with those skin disorders that still plays a role in current
society and is often supported by religious beliefs, although
compassion can be a modifying factor.59
Conclusion
This review has just started to scratch the surface of the spiri-
tual and religious aspects of skin and skin disorders. What
and how much skin is exposed, how the skin is painted or
decorated, tattooed, scarified, pierced, hair styled, nail styled,
and accessorized is determined by cultural norms, personal
preferences, spiritual aspects, and religious beliefs and
norms. Reactions to skin disorders have had and continue to
have extensive spiritual and religious aspects. Those afflicted
with skin disorders have often suffered as a result. Examples
have been included of spiritual and religious ­healing of skin
disorders by shamans and others through prayer and ritual
and by following spiritually obtained instructions, often
during ASC or during dreamtime. ­Modern understandings of
skin disorders and how to treat them have brought important
advances, but healing of the skin continues to have a spiritual
aspect and sometimes even today healing is hindered until
the spiritual aspect is adequately addressed.
Acknowledgment
Debrah Shenefelt is Rabbi of Congregation Or Ahavah, a
Jewish Renewal community.
Disclosure
The authors report no conflicts of interest in this work.
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